Individuals with HIV are more knowledgeable about their health insurance options than they were in 2014, and many are receiving care that meets their needs, according to a report by the Kaiser Family Foundation (KFF). While those who gained coverage under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) reported using their coverage regularly to treat their HIV, the expansion of Medicaid in states that have not yet done so would improve the health of HIV-positive individuals in those states. While the Ryan White program helps them manage their HIV, other health issues are going unaddressed.
The ACA and individuals with HIV
The ACA expanded access to affordable health insurance to millions of Americans, including those with HIV. Many individuals with HIV faced exclusions and other discriminatory road blocks in gaining health insurance before the ACA. Provisions that largely affected individuals with HIV include the creation of health insurance marketplaces and the availability of subsidies, the expansion of Medicaid in certain states, prohibitions on discriminatory market practices such as rate setting based on health status, preexisting condition exclusions, and the use of annual and lifetime coverage limits.
KFF studied focus groups of HIV-positive individuals in California, Florida, Georgia, New York, and Texas in mid-2014 to examine the care experiences under the ACA of people with HIV. As a follow-up, KFF took a second look at the same focus groups to see how the ACA affects individuals with HIV two years later. The focus groups consisted of HIV-positive individuals who gained health insurance coverage through marketplaces or Medicaid expansion, as well as those who remained uninsured because they fell into the coverage gap.
Increased understanding and security
KFF found that, in 2014, participants with new insurance coverage were in the early stages of learning how to use their insurance. In this round of research, participants reported that they used their coverage regularly to meet their care and treatment needs. The participants also reported that their health was easier to manage after gaining coverage and that they found relief and security in being covered. However, some still worried about being able to maintain coverage. However, those with Medicaid find recertification to be stressful.
Knowledge of insurance
Despite being better able to navigate using insurance compared to their 2014 counterparts, some participants remained unsure of how to fully assess plan options and, thus, relied on case managers to help them make enrollment decisions. These individuals continued to lack some basic insurance literacy, but KFF found that the individuals were more knowledgeable about how access to health care varied across the U.S.
Individuals in states that did not expand Medicaid who remained uninsured because they fall into the coverage gap feel like they can meet their care and treatment needs through the Ryan White Program, but they feel like other health problems are unaddressed. Nearly every participant—especially those with past Medicaid coverage—said if their state later expanded Medicaid, they would enroll.